Alzheimer’s Disease Caregivers: How to Improve Communication 9 Tips for Talking to a Loved One Dealing with Dementia

Caring for elderly loved ones can be challenging. And when Alzheimer’s robs them of the ability to talk, you both may feel lost. Read on for tips to communicate better and ease their frustration – and yours... You notice your father missed a doctor’s appointment or is forgetting common words. Soon, he repeats the same simple question or struggles to retrieve family members’ names. When advanced symptoms of dementia set in, he may speak less to avoid making mistakes or get angry when you try to help him. When you’re caring for an elderly person with Alzheimer’s disease, communicating can become one of your biggest challenges. But it’s critical to his well being. “People with Alzheimer’s want to maintain social relationships,” says Richard Caselli, M.D., professor of neurology at Mayo Clinic Arizona and clinical core director for the Arizona Alzheimer’s Disease Center. Communication also keeps them occupied when the disease limits their independence. “It prevents them from getting bored and looking for things to do,” Caselli says. “[Without it,] they may start wandering or get into some other trouble.” As a caregiver, you may be struggling with the best ways to offer support and keep your loved one from harm. Here are 9 tips that can help: 1. Speak gently and make eye contact. A person with Alzheimer’s disease has trouble processing the world around him, says Barbara Moscowitz, M.S.W., Li.C.S.W., of the Departments of Social Services and Geriatrics at Massachusetts General Hospital. “To him, it feels like he’s standing in the middle of chaos. Nothing makes sense.” Maintain a sense of calm by speaking in a normal voice and looking him in the eye so he stays focused on you. Resist the urge to speak loudly, which many of us do when we don’t think we’re being understood, says Laurie Spresser, a licensed therapist who works with Alzheimer’s patients and their families at Mayo Clinic Arizona. You want him to focus on your words, rather than your tone, which can prevent him from processing what you’re saying. 2. Keep it simple. Short, basic requests are most effective for getting your point across. As your loved one’s Alzheimer’s disease progresses, so will his ability to follow multi-step directions, says Beth Kallmyer, M.S.W., senior director of constituent services for the Alzheimer’s Association. For example, if you’d like laundry help, hand him a basket of clothes and ask him to fold them. A series of requests (take the clothes out of the washer, put them in the dryer, and fold them once they’re done) will frustrate him because he can’t remember all those steps. Eventually, you’ll need to break down even the simplest requests and pose yes-or-no questions, says Spresser. Instead of offering a choice like “Do you want coffee or tea?” ask him if he wants coffee and wait for an answer, she suggests. If he says no, ask him if he’d like tea. Although you’re simplifying your speech, don’t be condescending. Alzheimer’s patients have trouble communicating, but they are – in the early and middle stages – still able to recognize when they’re being talked down to, Kallmyer says. 3. Talk about feelings. Your loved one may have trouble expressing the frustration of living with Alzheimer’s disease. Offer comfort by identifying those feelings for him. When you see your loved one getting upset, “acknowledge the emotion – whether it’s anger, frustration or sadness – and offer to talk about it,” Kallmyer says. To open the conversation, you could say: “I know this is frustrating for you,” “You look sad” or “I know you like to be independent.” Even if he can’t respond, acknowledging his feelings can calm him down, Kallmyer says. 4. Ask how you can help. When you notice your loved one struggling with a simple task, like retrieving the right word, you might wonder whether to chime in or let him figure it out himself. “Some people with Alzheimer’s don’t want you to fill in the word,” Kallmyer says. “They feel patronized, which disrupts their thought process.” To find how to respond, wait a minute or two, and then say, “You just had trouble remembering a word. If that happens again, how do you want me to handle it?” If he doesn’t have an answer, suggest a secret signal, like pointing at you or patting your arm when he wants you to help. “It helps when family members talk about these things and agree on a strategy,” Kallmyer says. 5. Create a reminder system. In the early stages of Alzheimer’s disease, your loved one may be able to live on his own – with a little help. Keeping to a schedule can be one of the most challenging tasks, so work out a system of reminders. Mark a calendar with tasks and events, such as doctor’s appointments. If he’s not able to follow the calendar, call every morning and review the day’s schedule. Offer to drive him to his appointments to ensure he makes them. A trusted friend or neighbor can also help with reminders or trips to important appointments, if you’re unable to do so. 6. Add labels to common objects. Notes and signs can help Alzheimer’s patients get through the day more independently. Use a label maker or post sticky notes on the TV remote, for example, to identify what it is and the right button to push to turn it on. Labels on dresser drawers can make it easier for him to dress himself, and signs on doors will help him locate the bedroom or bathroom. Labels don’t have to be limited to written notes, says Kallmyer. You can use them in conversation as well. If your loved one is having trouble recognizing people, for example, identify them as they approach. Use short, specific sentences, such as, “Dad, Bobby’s here. He’s my son, your oldest grandson.” At mealtime, you could say, “I have your lunch. It’s tomato soup. Here’s the spoon. It’s time to eat.” Visual cues help too. As you name objects, point to them to jump-start recognition, suggests Spresser. Your loved one may even learn to mimic this behavior and point to an object when he can’t recall its name, she adds. 7. Use the power of touch. As your loved one’s symptoms of dementia increase and his ability to express himself decreases, he’ll appreciate a hug or a hand to hold. In fact, touch can become the most important form of communication you have. If he seems frustrated or anxious, rest your hand on his to calm him down. Touch can also help you guide his actions. At bedtime, take his hand, help him up from his chair, and guide him toward the bedroom. At mealtime, direct his hand to the fork or spoon. Touch also helps you stay connected, especially in later stages of the disease. “Talk about memories of things you did together, and hold or rub his hand,” Kallmyer suggests. “You might get a smile.” 8. Don’t argue about facts. Your loved one will have trouble understanding why he’s misplacing things. As a result, he can become suspicious or accuse you of moving, or stealing, his belongings. Try not to argue or reason with him. It will only make things worse, says Spresser. “You can’t use logic; your loved one may not be able to understand it.” Instead, acknowledge the emotions: “I see you’re angry. I know it’s frustrating when you lose something.” Then offer to help him. When all else fails, change the topic. Ask him if he’d like to take a walk or wants a snack. 9. Go with the flow. As Alzheimer’s disease progresses, communication problems will change, so solutions must too. “The progression of the disease isn’t necessarily linear,” Kallmyer says. “Your loved one can appear to have a symptom one day, and then be better the next. It goes back and forth.” Often, you’ll have to be flexible and try new approaches to find what works. If a tactic fails once, try it again another time. You might have better luck later. Learn more in our new Alzheimer’s Disease Health Center . To find a caregiver’s support group in your area, visit the Alzheimer’s Association website or call their 24-hour caregiver’s hotline: 1-800-272-3900. How Much Do You Know About Alzheimer’s Disease? More than 5 million Americans have Alzheimer’s disease, and that number could climb to 16 million by 2050. Women face a higher risk of developing it than men, and are also more likely to become caregivers.